What are Aetna breast reduction requirements?

Question

So I have been wanting a reduction for 13 years but put it off until I was done having kids. After having twins 5 years ago, my body is quite a mess. I am 5'8" with 38G breasts. Over the past two years I have lost over 50 pounds and kept it off. My concern is Aetna requires around 800g taken from each breast as their requirement to cover. I'm worried that would leave me with nothing. Have you ever heard where insurance would approve a reduction where the full amount of 900g isn't taken?

Jeffrey E. Schreiber, MD, FACS · Answer

I have had similar problems with Aetna.  If you don't want to be too small consider paying out of pocket.

Ryan Hoffman, MD · Answer

These issues differ by region, where each insurance company can demand different amounts of breast tissue. In my area, Aetna sometimes wants twice as much breast tissue taken as the other insurance companies. I counsel my patient to either switch insurance companies, if I feel they will be able to be covered under a different insurance provider, or to pay for the procedure out of pocket. This allows the surgeon to focus on making the breasts match with your chest wall and to give you a great result and not to be constrained by an insurance mandated number. If your surgeon does not feel they will be able to leave you with adequate breast tissue then you should not undergo a reduction through insurance.

Joseph L. Kiener, MD, FACS · Answer

Some insurance companies use the Schnur sliding scale based on body surface area, calculated on your height and weight.   Aetna has their own sliding scale which requires more from smaller patients relative to the Schnur scale, but maxes out at 1000 gms per breast.  Other just require 500 grams no matter what your height and weight.  And if you are in Canada the surgeon decides.  In this age of increasing out of pocket expenses and deductibles seek out a board certified plastic surgeon who will do it as a cosmetic procedure.  Sometimes you end up saving money and you can dictate your cup size .  Regards.

Leland Deane, MD, FACS · Answer

800 or 900 grams sounds like a lot to remove. Sometimes this much is removed. The only problem is that you want to allow the surgeon as much flexibility during the procedure and you don't want his decisions limited. Without seeing you or seeing photos it is impossible to determine but I usually determine 500 grams in my patients and this gives me freedom to make the right decision. Best of luck.

Maria M. LoTempio, MD, FACS · Answer

Thank you for your question. Generally when an individual has G size breast a full C is a good goal. Most of the time the goal of 800 grams is met with reduction. Please see a board certified plastic surgeon and she/he can advise you. Best of luck.

What are Aetna breast reduction requirements?

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Answer: Breast Reduction insurance requirement

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What are Aetna breast reduction requirements?

Answers (6)

Answer: A lot

Answer: A lot

Answer: Breast Reduction insurance requirement

Answer: Breast Reduction insurance requirement

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Everything you need to know about Breast Reduction

Our mission is to create a world where every investment in modern beauty is Worth It.